| Objective:1.to explore the predictive value of cum BP on all-cause mortality,cardiovascular and cerebrovascular events predict value.2.to explore the predictive value of cum BP on new-onset atrial fibrillation.3.to explore the predictive value of cum BP on eGFR decline.Methods:A prospective cohort study,These participants were then followed through every two years with repeated questionnaires and physical examinations.Finally,we included 57,927 people in our cohort.The effects of cum SBP and cum DBP on all-cause mortality and cardiovascular incidents,new-onset atrial fibrillation(AF),e GFR-decline Hazard ratios(HRs),and 95% confidence intervals(CIs)were further analyzed using the COX proportional hazards model and the natural spline function.Result:All-cause mortality and cardiovascular events were followed up for an average of 5.91 ± 0.69 years.There were 1815(3.5%)cases of all-cause mortality,1653(3.2%)cases of cardiovascular and cerebrovascular events and 391(0.7%)cases of myocardial infarction,1240(2.4%)cases of stroke(of which 22 had myocardial infarction at the same time).The new AF events was followed up average4.97±0.37 years,during the follow-up period with a total of 90(0.2%)new-onset AF events.Average follow-up of e GFR decline 3.49 ± 1.03 years,21457(63.1%)cases of new e GFR<90ml /(min · 1.73m2)occurred during the follow-up period.1.All-cause mortality,cardiovascular events,stroke events,myocardial infarction events,new-onset AF and e GFR<90ml/(min·1.73m2)were taken as dependent variables and cum SBP / cum DBP as independent variables.After adjusting for the other risk factors,the results showed that for every 10 mm Hg · year of cum SBP,The HR(95% CI)of all-cause mortality,cardiovascular events,cerebrovascular events and acute myocardial infarction,new-onset AF,and e GFR decline was 1.019(1.013~1.024),1.022(1.017~1.027),1.019(1.008~1.030),1.024(1.018~1.030),1.034(1.012~1.057),1.016(1.014~1.017)and 1.015(1.010~1.019),1.018 (1.014~1.022),1.013(1.003~1.022),1.020(1.015~1.025),1.026(1.008~1.044),1.014(1.013~1.015)for every 5 mm Hg · year of cum DBP.2.Natural spline function analysis showed that after adjusting for confounding factors,cum SBP and cum DBP of the total population showed a similar "J" shaped curve with all-cause mortality risk or stroke events.3.Adjusted for other risk factors,men increase new-onset atrial fibrillation and e GFR decline,HR(95%CI)1.963(1.028~3.747),1.424(1.375~1.475);each additional 1 years of age,the incidence of new onset atrial fibrillation and e GFR decline increased,HR(95%CI)1.099(1.077~1.122),1.015(1.013~1.016);for each additional BMI 1mg/m2,the incidence of new-onset atrial fibrillation and e GFR decline increased,,HR(95%CI)1.108(1.052~1.166),1.007(1.002~1.011);the diabetes increased e GFR reduction,HR(95%CI)1.074(1.063~1.084);for each LDL-C increase 1mmol/L,e GFR decline increased,HR(95%CI)1.055(1.038~1.073);antihypertensive drugs and physical exercise reduce the incidence of e GFR reduction,the value of HR(95%CI)0.798(0.758~0.841),0.903(0.867~0.941).Conclusions:1.The cum BP has predictive value for cardiovascular and cerebrovascular disease,all cause mortality,new atrial fibrillation,e GFR decline,and its predictive value is better than baseline blood pressure.2.The cum BP has "J" curve curve relationship with all-cause mortality risk or stroke events.Therefore,we should pay more attention to the cum BP during anti-hypertension,too low or too high will have adverse effects on target organs.3.In addition to cum BP,the independent risk factors for new onset atrial fibrillation include male,aging and increasing level of BMI,hs-CRP,uric acid,while TC is a protective factors for atrial fibrillation.The independent risk factors of e GFR decline include male,aging and increasing level of BMI,diabetes history and blood lipids.Taking antihypertensive drugs and physical exercise is a protective factor for e GFR decline. |
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